Document Submittal Form - Voluntary Dismissal of Appeal

This form is only to be used by the party that filed the appeal.

REQUIREMENTS:

You must have a docket number.

Use a separate transmission for each appeal. Transmissions containing more than one docket number will be rejected and filing will not be accomplished. Submit in electronic format only. After successful submission, DO NOT SEND A HARD COPY.

You must enter an email address to receive email confirmation of successful
submission.

If you do not see "Your document has been submitted." your form has NOT been
received by the BIIA.

Documents received after 5 p.m. will be deemed filed the next business day. WAC 263-12-015(3) and WAC 263-12-01501.

QUESTIONS: Please call 360-753-6823.

Submitter information

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Your name:*

Contact e-mail:*

Document information

BIIA Docket number:*

By submitting this request, I certify that I am the individual that filed this appeal; or the representative of the individual that filed this appeal. I understand that this action will end the appeal and the Department of Labor and Industries decision that was appealed will not be changed. A further appeal cannot be filed from the Department of Labor and Industries decision.